‘If you think you understand the Belgian linguistic conflict, then obviously no one explained it properly to you.’1 Smoking remains one of the world’s leading causes of ‘death, illness and impoverishment’.2 Tobacco use continues to represent a major public health challenge,3–7 resulting in 7 million deaths annually.2 Although smoking rates in Belgium are slightly below the European Union (EU) average, they are still unacceptably high,8 with smoking a major cause of mortality and morbidity.3,9,10 Belgium has an overall adult smoking prevalence of 16.8% (male 18.5%, female 15.3%).8 It is imperative therefore that all means necessary are used to combat this threat. Belgium has a significant history of language conflict,1,11,12 and is one of six countries within the EU with more than one official language. Ireland, Cyprus, Finland, Malta and Luxembourg are officially bilingual, with Belgium being the only officially trilingual state within the EU. Article 2 of the Belgium Constitution states that ‘Belgium comprises three Communities: the Flemish Community, the French Community and the German-speaking Community’. In line with the EU’s Tobacco Products Directive anti-smoking warnings in Belgium on tobacco products are therefore printed in all three official languages (French, ‘Dutch’ and German). Although the German community is comparatively tiny, representing just 0.5% of the population, the ‘Dutch’ speaking community constitutes 56% of the population, with the French speaking population constituting 43.5%.1 However, as can be seen from Fig. 1, which details an example of the EU mandated anti-smoking warnings used in Belgium, French appears first on the warnings, followed by ‘Dutch’ and then German. Given the population of Belgium is ~11 million, this means that the ‘Dutch’ speaking population numbers almost 1.4 million more than the French speaking population. In light of the history of French linguistic dominance in Belgium, particularly in the legal and administrative arena,12,13 the question needs to raised as to whether this historical artefact is appropriate? Fig. 1 View largeDownload slide Example of an EU mandated combined anti-smoking graphic used in Belgium. Fig. 1 View largeDownload slide Example of an EU mandated combined anti-smoking graphic used in Belgium. Although the language boundary between the Flemish and Walloons effectively cuts the country into a ‘Dutch’ speaking north and a French speaking south, research suggest that among men ‘premature mortality due to lung cancer does not exhibit a strong geographical pattern’.9 Among women the pattern is described as an East-West gradient, rather than one based on longitude.9 Positive discrimination based on different lung cancer rates would not then appear to be adequate justification for this pattern of linguistic dominance. The significant adverse impact of smoking has already been noted. Given importance of brevity, and easy interpretability essential in health promotion messages, as well as the importance of a self-referential element in risk communication, the current language order of anti-smoking combined warnings in Belgium should be reviewed. Although research has examined the impact of plain packaging of cigarette packets on particular linguistic groups in Belgium, little research has addressed the issue of language order in anti-smoking warnings. Further investigation of language issues in anti-smoking warnings throughout the EU and further afield is warranted. Conflicts of interest Authors declare no conflicts of interest. Ethical approval Not required as to human participants were involved with this letter. Authorship All authors made significant contributions in the write up, review and redrafting of this letter and give final approval for its publication. Funding This research was funded by the Graduate and Research Office at Limerick Institute of Technology under the provision of a PhD bursary. References 1 Van der Linden N , Roets A . Insights into the Belgian Linguistic Conflict from a (Social) psychological perspective: introduction to the special issue . Psychol Belg 2017 ; 57 ( 3 ): 1 – 12 . Google Scholar CrossRef Search ADS 2 Tobacco [Internet] . World Health Organization. 2018 [cited 11 April 2018]. http://www.who.int/mediacentre/factsheets/fs339/en/ 3 GBD 2015 Tobacco Collaborators , et al. . Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015 . Lancet 2017 ; 389 : 1885 – 1906 . CrossRef Search ADS PubMed 4 World Health Organisation Report on the Global Tobacco Epidemic, 2008 . The MPOWER Package . Geneva : World Health Organization , 2008 . 5 Öberga M , Woodward A , Jaakkolac MS et al. . Global Estimate of the Burden of Disease From Second-hand Smoke . Geneva : Wold Health Organisation , 2010 . 6 Lim SS , Vos T , Flaxman AD et al. . A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 . Lancet 2012 ; 380 : 2224 – 60 . Google Scholar CrossRef Search ADS PubMed 7 World Health Organization . WHO Report on the Global Tobacco Epidemic, 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship . Luxembourg : World Health Organisation , 2013 . 8 Tobacco consumption statistics . Statistics Explained [Internet]. 2018 [cited 11 April 2018]. http://ec.europa.eu/eurostat/statistics-explained/index.php/Tobacco_consumption_statistics 9 Renard F , Tafforeau J , Deboosere P . Mapping the cause-specific premature mortality reveals large between-districts disparity in Belgium, 2003–2009 . Arch Public Health 2015 ; 73 ( 1 ): 13 . doi:10.1186/s13690-015-0060-5 . Google Scholar CrossRef Search ADS PubMed 10 Menvielle G , Kunst AE , Stirbu I et al. . Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations? Int J Cancer 2007 ; 121 ( 3 ): 649 – 55 . doi:10.1002/ijc.22721 . Google Scholar CrossRef Search ADS PubMed 11 Engel M . Behind the net curtains. New Stateman, 17–23 November 2017: 26–9. 12 Bollen K , Baten K . Bilingual education in Flanders: policy and press debate (1999–2006) . Modern Lang J 2010 ; 94 ( iii ): 412 – 33 . Google Scholar CrossRef Search ADS 13 ter Hoeven PJA . The social bases of Flemish nationalism . Int J Soc Lang 1978 ; 15 : 21 – 32 . © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Journal of Public Health – Oxford University Press
Published: May 29, 2018
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